07/10 July, 2014 Salamanca, Spain
Organised by
In Association width
Supported by
Registration Form
 PERSONAL DATA
Mr. Ms.
First Name:
Family Name:
Identity document:
Number:
Nationality:
Date of birth:
Format: dd/mm/yy
Personal Address:
Zipcode:
City/Town:
Province / Country / State:
Tel.:
Fax:
E-mail:
Repeat E-mail:
Institutional affiliation - Department Company:
Title (Dr/Prof):
Terms:
Required fields
INVOICE DETAILS (if different than the above)
Initially the invoice will be fill in with the information provided in this registration form. If you need any change in your invoice, please use the box below:
-The official invoice will be provided directly in the congress-
Institution Name:
Institution Address:
Zipcode:
City/Town:
Province:
Tel.:
Fax:
E-mail:
VAT Number

 REGISTRATION
   
Before June 1, 2014
After June 1, 2014
ON SITE
Regular
685,00 €
750,00 €
800,00 €
Students (*)
325,00 €
350,00 €
400,00 €
Accompanying person (REDUCED)(**)
235,00 €
235,00 €
--
Accompanying person (FULL)(***)
345,00 €
345,00 €
--
Additional contributions
315,00 €
315,00 €
--
Additional page (4 pages max.)
85,00 €
85,00 €
--
(*) STUDENTS must provide proof of their status with a copy of their student card sent with the registration form. The document has to be presented when collecting the documentation
(**) Reduced rates are mainly applicable to accompanying persons REDUCED(includes lunches, coffee breaks and social programme) http://www.fusion2014.org/social
(***) Reduced rates are mainly applicable to accompanying persons FULL (includes one-day excursions, lunches, coffee breaks and social programme) http://www.fusion2014.org/excursions

  CONTRIBUTION:

INFORMATION:
Each regular registration covers two contributions. The fee of each additional contribution is 315€.
Each student registration covers one contribution. The fee of each additional contribution is 315€.
The registration fee cover 8 pages for contribution. The fee of each additional pages (up to 12) is 85€.

I DO NOT SUBMIT ANY CONTRIBUTION

CONTRIBUTION  (Included - Regular & Student registration)
Id: Event:
Title:
Nº Additional Pages (1, 2, 3 or 4)
    €85 for each additional page (Up to 12)
CONTRIBUTION  (Included - Regular registration)
Id: Event:
Title:
Nº Additional Pages (1, 2, 3 or 4)
    €85 for each additional page (Up to 12)
CONTRIBUTION  
Id: Event:
Title:
Nº Additional Pages (1, 2, 3 or 4)
    €85 for each additional page (Up to 12)
CONTRIBUTION  
Id: Event:
Title:
Nº Additional Pages (1, 2, 3 or 4)
    €85 for each additional page (Up to 12)

 TUTORIAL
     
Early Bird (before June 1st 2014)
Regular + On Site (after June 1st 2014)
One Tutorial  
180 €
225,00 €
Two Tutorials  
300 €
360,00 €
Three Tutorials  
380 €
450,00 €

 ADDITIONAL INFORMATION – Food intolerances:
Vegetarian
Strict vegetarian
Celiac
No pork
Other

 Social Programme
     
Units
additional Gala Dinner Ticket  
95,00 €
One-day excursions - 8th July. Guided visit to Ciudad Rodrigo
55,00 €
One-day excursions - 9th July. Long guided visit to Salamanca
55,00 €
One-day excursions - 10th July. Excursion to the mountains of Salamanca
55,00 €

 HOW TO PAY:
Bank Transfer

Bank transfer for CONGRESUAL S.L.L. payable to CAIXA BANK

Account Number: 2100-3753-7622-0006-2955 .
IBAN: ES95 2100-3753-7622-0006-2955
BIC/SWIFT CODE: CAIXESBBXXX

Owner of the Account Number: (Technical Secretariat)
CONGRESUAL, S.L.L. (VAT number: B-37495116)
Address: C/ Camelias, 470 -37449 –Galindo y Perahuy (Salamanca) Spain.

Attach a copy of the transfer to this newsletter indicating the concept of payment by email to the mailbox: fusionregistration@usal.es


Only VISA or MasterCard Credit Cards
You will be transferred directly to the secure on-line payment. (directly with the bank)
This process will be done through the secure area of the bank.
This is an automatic process. If you have any problem, please contact with you bank


 VALIDATION CODE
Validation Code:
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